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Evidence suggests subclavian central venous catheters have fewer complications (e.g., less thrombosis and infection) compared to catheters at other sites. The benefits come at increased risk for potential complications during placement using the landmark technique (e.g., pneumothorax and arterial puncture). Ultrasound-guided subclavian cannulation is gaining popularity and is actively being studied.
How to do it:
1. Find the axillary vein; located caudal to the distal third of the clavicle (see reference).
2. Distinguish artery from vein with compression and/or Doppler.*
3. Sterilely prep the site and ultrasound probe.
4. Cannulate the vein in the transverse or longitudinal plane.
*Note: Some recommend following the axillary vein medially until it becomes the subclavian vein and cannulating this site.
References
Skolnick ML. The role of sonography in the placement and management of jugular and subclavian central venous catheters. AJR Am J Roentgenol. 1994 Aug;163(2):291-5.